Tying it All Together: Why Does Someone Become Suicidal?

Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.

We have already discussed risk factors/vulnerabilities and triggers that may lead someone to commit suicide. Researchers have tried to weave these risk factors and triggers into a clear picture of the reasons why someone attempts or commits suicide. Suicide is not a simple behavior. Therefore, the explanations are complex and made up of different layers of factors. Most researchers and clinicians agree that suicide is the result of the interaction between psychological, biological, and sociological factors. Each these factors do not occur in isolation, but interacts with and influences the others. Some research suggests that there may even be subtle differences between people who attempt suicide and those who complete it.

Psychological Contributions

Psychodynamic Explanations

Traditional psychodynamic theories are based on the idea that mental illness and problems result from internal, unconscious conflicts. Freud (the creator of psychodynamic theories) thought that suicidal and homicidal behavior were two sides of a similar coin. He suggested that we have two basic drives. One drive is oriented toward love and life (called Eros), and the other toward death (Thanatos). Freud suggested that people who function well are able to balance and integrate these drives. For instance, a healthy person would be able to engage in loving relationships and a wide variety of stimulating and growth-oriented activities. The person would also be able to pull back from the world, and other people, when it is necessary to conserve physical and mental energy. In contrast, if these drives are unbalanced, a person's destructive impulses may surface, resulting in violence against others (homicide) or violence against oneself (suicide).

Object relations theory is a contemporary psychodynamic theory. It suggests that people can become suicidal or homicidal as a result of a difficult early relationship with a caregiver object. This caregiver object is another person, such as a parent, who is represented in memory. The inappropriate relationship leads to a fear of engulfment (being completely overtaken by the object) or abandonment (being completely abandoned or rejected by the object). This fear leads to an internal conflict that can become so intense that people seek a method to relieve it. Sometimes, this release is achieved by harming someone else, or themselves.

Cognitive-Behavioral Explanations

Cognitive-behavioral theories suggest that people become suicidal because they have learned to think and behave in characteristic and unhelpful ways. These ways make suicide seem like an appropriate choice and/or coping strategy. According to these theories, how suicidal people think about stressful situations (rather than the stressors themselves) will predict how they will react to them. Both maladaptive thought patterns (called cognitive distortions) and inappropriate behavior (or a lack of skills/behavior) can propel someone toward harming themselves. It's a "chicken and egg question" in terms of which comes first. For some people, a characteristic thinking style, presents very early on (see our discussion on temperament) and leads to unhelpful behavior. For others, specific behaviors and the resulting feedback (or consequences) leads to maladaptive thoughts.

Cognitive distortions that can potentially lead to suicide include:

Black or White Thinking - portraying oneself and the world in black and white. For example, thinking "my life is completely horrible", rather than "I, like everyone else, have good and not so good aspects of my life/situation/self".

Overgeneralization - assuming that one bad event means that the whole day (week, year, etc.) will be bad.

Minimization - this is the "flip side" of overgeneralization. The person assumes that a good trait or event is unimportant or "a fluke." For example, "I did well on that presentation, but it's only because no one was paying attention to me."

Selective Attention - focusing only on negative information or information that confirms other negative or unhelpful thoughts. For example, thinking "I can't do anything right" and then reviewing your week for only those things that you messed up on, rather than also considering the things you did well.

As discussed previously, one particular way of thinking raises a serious red flag with regards to suicidal behavior. People may become (or are currently) suicidal if they feel hopeless - or that things will never get better.

Behavior that can potentially lead to suicide includes skill deficits and maladaptive coping styles. For example, people who have never learned to be appropriately assertive (a skill deficit) may repeatedly be taken advantage of or lose out on important opportunities such as job promotions, meeting new friends, etc. These behaviors may lead to one of the cognitive distortions described above (e.g., black and white thinking; such as "I am a total loser because I can't make friends").

Research also suggests that suicidal individuals often have not learned appropriate coping styles. Coping styles/skills describe how well someone can manage a stressful situation. It also describes how they regulate their emotional, physiological, behavioral, and cognitive reactions to stressors. Active coping styles include planning/problem solving, seeking and use social support, and reinterpreting and finding meaning and benefit from negative events. Suicidal individuals use fewer active coping strategies and more avoidant (passive) coping styles such as suppression (avoiding or denying the stressor) and blaming oneself for the cause of events. In addition, those suicidal people who try to be more active in solving problems tend to rely on an impulsive method than a more logical and methodical process.

Unhelpful behaviors and thoughts often intertwine in a particularly maladaptive state referred to as "learned helplessness." Individuals in this state have a style of thinking referred to as an "internal locus of control." People with this pattern of viewing the world tend to think that negative life events are caused by internal (i.e., from me), stable (i.e., not changeable), and common causes. In other words, bad things happen, they are completely my fault, and I can't change them or prevent them from happening. People who show learned helplessness "give up trying" and use passive coping skills because they believe that they can't impact negative outcomes or control their moods. An internal locus of control and learned helplessness can lead to ongoing feelings of hopelessness; which again, is often a trigger for suicidality.